Provider Demographics
NPI:1689688384
Name:STRUVE, ADONA CHRISTINE I
Entity Type:Individual
Prefix:
First Name:ADONA
Middle Name:CHRISTINE
Last Name:STRUVE
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADONA
Other - Middle Name:CHRISTINE
Other - Last Name:SIMMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1224 W. ROOSEVELT BLVD.
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-2820
Mailing Address - Country:US
Mailing Address - Phone:704-296-4800
Mailing Address - Fax:704-296-4807
Practice Address - Street 1:1224 W. ROOSEVELT BLVD.
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-2820
Practice Address - Country:US
Practice Address - Phone:704-296-4800
Practice Address - Fax:704-296-4807
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101014363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q67125Medicare UPIN